Fourth National Conference on
Quality Health Care for Culturally Diverse Populations:
Integrating Community Needs into the National Health Agenda

September 28-October 1, 2004, Washington, DC
Hilton Washington, Washington DC

Workshop D-4: Managing diabetes in a culturally appropriate way: an interactive learning session

James R. Gavin III, M.D., Ph.D., graduated from Livingstone College in Salisbury, N.C., in 1966 with a degree in chemistry. He earned his Ph.D. in biochemistry from Emory University in 1970 and his M.D. degree from Duke University School of Medicine in 1975.

Dr. Gavin began his current position as President of the Morehouse School of Medicine on July 1, 2002. Prior to that, he was senior scientific officer at the Howard Hughes Medical Institute (HHMI) from 1991-2002 and director of the HHMI-National Institutes of Health Research Scholars Program from 2000-2002.

Before joining the senior staff of HHMI, he was on faculty at the University of Oklahoma Health Sciences Center as a professor and as chief of the Diabetes Section, acting chief of the Section on Endocrinology, Metabolism and Hypertension, and William K. Warren Professor for Diabetes Studies. He previously served as Associate Professor of Medicine at Washington University School of Medicine in St. Louis. He was a lieutenant commander in the U.S. Public Health Service from 1971-73 and continues to serve as a reserve officer in the USPHS.

Dr. Gavin belongs to a number of organizations, including the Institute of Medicine of the National Academy of Sciences, the American Diabetes Association, the American Society of Clinical Investigation, the American Association of Physicians, the Alpha Omega Alpha Medical Honor Society, the Association of Black Cardiologists, Omicron Delta Kappa Honorary Society and the Sigma Pi Phi Leadership Fraternity. He is a past president of the American Diabetes Association and was voted Clinician of the Year by ADA in Diabetes in 1991. He has served on many advisory boards and on the editorial boards of the American Journal of Physiology and the American Journal of Medical Sciences. He is on the board of trustees for Duke University, Emory University, MicroIslet, Inc., and the Robert Wood Johnson Foundation, and is a member of the Board of Baxter Pharmaceutical Corporation. He is national program director of Harold Amos Faculty Development Program of the Robert Wood Johnson Foundation. Dr. Gavin is chairman of the National Diabetes Education Program and a past member of the Advisory Council to the NIDDK. He is also chairman of the Data Safety Monitoring Board for the VA Cooperative Diabetes Study.

He has published more than 180 articles and abstracts in such publications as Science, Journal of Applied Physiology, Diabetes, and the American Journal of Physiology. He is author of two books “Healing our Village: A Self-Care guide for diabetes control” (with L. Coleman), and “Dr. Gavin’s Health Guide for African Americans” (with S. Landrum).

Among the many honors Dr. Gavin has received are the Daniel Hale Williams Award, the E.E. Just Award, the Herbert Nickens Award, the Daniel Savage Memorial Award, the Emory University Medal for Distinguished Achievement, the Banting Medal for Distinguished Service from the American Diabetes Association, the Distinguished Alumni Award from the Duke University School of Medicine, and the Internist of the Year from the National Medical Association.

Dr. Gavin and his wife, Annie, have been married for 32 years and they have three adult sons.

Building a Multi-Disciplinary Approach to Culturally Competent Care of Diabetes

The Latino population-the fastest growing and largest minority group in the U.S.-are at significantly higher risk for diabetes and its complications in comparison to other ethnic groups. Unfortunately, sufficient culturally oriented comprehensive diabetes care, education and research programs are lacking. In response to these challenges, The Joslin Diabetes Center launched the Latino Diabetes in 2002 to concentrate in four major areas: diabetes care and education, community outreach, provider education and clinical research.

1. The Diabetes Care and Education Program provides services by a multidisciplinary team of bilingual/bicultural professionals under the Joslin Care model. The activities comprise individual consultations with an endocrinologist, ophthalmologist, neurologist, a teaching nurse, a dietitian and/or an exercise physiologist, as well as a series of group education modules. A1c levels have gradually decreased in new patients attending the Clinical Program, from an average first-time score of 9.09% to 7.85% after 20-25 months in the program. A dedicated case manager/data coordinator is key in helping us understand outcomes and areas for improvement, as well as support us in remaining adaptable to the needs of our patient base.
2. The Community Outreach component of the Initiative extends the reach of the program into local community health sites and other community-based collaborators. Ongoing programs include mini-diabetes clinics located in existing community health centers, participation in community events, group education programs in schools and churches, as well as collaborations with other public health and advocacy agencies to build awareness about diabetes prevention and control.
3. Research remains a key component of the Initiative. The increasing number of Latinos with diabetes in the US demands culturally appropriate diabetes care and education programs. In order to develop such programs, socio-economic and cultural factors need to be assessed. As part of the initial evaluation of new patients to the Latino Diabetes Initiative Clinical Program at Joslin Clinic, we have integrated a series of questionnaires (validated in Spanish) to assess some of these variables. The data we have collected has helped us to understand the fundamental lack of basic diabetes knowledge and serious socio-economic and cultural challenges our patients face. Based on our findings from this research, the Initiative is currently developing low-literacy supplementary education on audiocassettes for our patients to reinforce key learning objectives.
4. Through ongoing Continuing Medical Education CME programs and lectures, members of Latino team are able to share their knowledge base with clinicians on a national level, and in turn gain recognition for the innovative work of the Initiative both in research as well as clinical care and education.

The co-presenters from Joslin will discuss, through a training-oriented session, how their own experiences in building a multi-disciplinary program for Latinos can inform others interested in beginning related programs in their own institutions. Discussion will include how to create synergies between larger, more established institutions and a smaller, entrepreneurial program. Other challenges—integrating a full-service clinic serving a distinct patient population, finding opportunities for collaboration in other areas of health institution, and developing evaluation programs—will also be reviewed with an eye toward skill-building.

Kirsten Ward has been with Joslin Clinic since 2001. Since October 2003, Kirsten has served as the Latino Program Coordinator for the Latino Initiative. She works with a team of educators and staff to develop culturally appropriate materials and cultural awareness in the health field. Fluent in Spanish, she educates Latinos on the benefits of activity and how to improve their blood glucose control. Kirsten also speaks both nationally and internationally on issues related to diabetes and exercise as well as culturally competent models of care. Speaking engagements include presenting to the New Hampshire Department of Health, Elliot Hospital, in Manchester, New Hampshire and most recently in Bogota, Colombia at their 25-year anniversary of diabetes care. She received her B.A. from Connecticut College in Dance and Hispanic Studies and her M.S. in Exercise Physiology from the University of Massachusetts, Amherst. Kirsten just completed her 5th Boston and 10th Marathon this past April 2004.

Clare Abeln currently manages the diverse needs of the Community Outreach Office at Joslin Diabetes Center. She participates in and supports community-based diabetes care and education projects, periodic provider education for community health professionals, outreach and promotional events, and she collaborates with local, state and regional agencies and institutions working on diabetes and related health issues in disadvantaged communities. Clare has an M.B.A. from Babson College and experience in marketing management and strategic consulting in both the investment and medical industries.

Kirsten Ward, M.S., R.C.E.P., C.D.E.
Latino Program Coordinator, Latino Diabetes Initiative
Joslin Diabetes Center, One Joslin Place, Boston, MA 02215
617-732-2421
kirsten.ward@joslin.harvard.edu
www.joslin.org/latino

Clare Abeln, M.B.A.
Manager, Community Outreach Programs
Joslin Diabetes Center
617-735-1977
clare.abeln@joslin.harvard.edu

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